Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are the most common pain regimens that you use in cancer care?
Malignant pain is common, and oncologists should be comfortable initiating management in their patients. Let's imagine, for this case, that local therapies for a focal pain have been explored and we've decided it's time for medication/systemic approach. After an initial screening question for a subs...
How do you approach laboratory assessment for anticoagulation adherence when working up anticoagulation failure?
When faced with an anticoagulation failure, my go-to test for adherence is looking at the medication-dispense report (if you have this available at your institution, it is very handy for understanding the patient's adherence to anticoagulation). Typically, this will either show intermittent dispensi...
What are your top takeaways in Medical Oncology from SABCS 2024?
I would give the following studies the top 3 in terms of impact: GS2-12:The PATINA study, that tested the use of palbociclib in patients who were on maintenance first-line therapy after induction therapy for metastatic HER2 and hormone receptor-positive breast cancer with taxane or vinorelbine plus ...
What is the best way to prepare children with von Willebrand disease for tonsillectomy to reduce the risk of post-operative hemorrhage?
I am an adult provider, but the treatment is similar regardless of age. The exact treatment plan will vary depending on the type and severity of VWD (i.e., mild type 1 VWD vs type 2B VWD); however, for tonsillectomies, I provide VWF concentrate 40-80 IU/kg 5-30 min preoperatively, followed by postop...
How do you treat vaginal dryness associated with estrogen deprivation therapy for ER+ and/or PR+ breast cancer?
This is a common problem for many postmenopausal women or those on ovarian suppression. A gynecology exam is important to make sure symptoms are specifically due to estrogen deprivation and not compounded by other causes. A number of options can help including coconut oil/olive oil, vaginal moisturi...
Do you incorporate the ALASCCA trial into your clinical practice and perform NGS on all early stage colon cancer patients to determine if adjuvant aspirin would be beneficial?
Yes, I recommend obtaining PIK3CA testing on patients with resectable colon and rectal cancer based on the ALASCCA trial, as well as other data for patients who are able to receive low-dose aspirin if they have a PIK3CA mutation. NCCN guidelines currently recommend post-surgery/adjuvant therapy aspi...
How long would you anticoagulate for a catheter associated DVT in pregnancy?
Available guidelines for management of catheter-related DVT, including the 2012 ACCP CHEST guidelines, typically recommend 3 months of anticoagulation if the central venous catheter (CVC) is removed. In those who require ongoing CVC placement, which is common in patients with cancer requiring system...
How often do you check weight and adjust anticoagulation dosing in pregnancy?
In patients on prophylactic or intermediate doses of Lovenox (e.g., 1 mg/kg once daily), I do not adjust the dose during pregnancy. (Although this "intermediate-dose" approach is not supported by the Highlow trial, I will use 1 mg/kg daily in a woman with a more extensive clotting history—such as a ...
For patients with intermediate or lower risk essential thrombocythemia with plt >1000 but no symptoms, do you favor aspirin only therapy or aspirin and cytoreduction?
First, the wrong question is being asked. The correct question is, what is the proof that the low-risk, intermediate-risk, or high-risk ET classification has any validity? My answer would be that this classification has no validity. Whether it is based on the IPSET scoring system or one of the other...
Do you consider thrombocytopenia a contraindication for fibrinolytic therapy for a massive PE?
If one has access to mechanical thrombectomy devices and operators, they should be considered before systemic thrombolytics unless the massive PE is causing imminent danger to the patient/patient is going to code/die, in which case the risk of dying from said PE is higher than potential bleeding eve...